The Effects of Intraabdominally Insufflated Carbon Dioxide on Hepatic Blood Flow During Laparoscopic Surgery Assessed by Transesophageal Echocardiography

Abstract

Conflicting results have been published about the effects of carbon dioxide (CO(2)) pneumoperitoneum on splanchnic and liver perfusion. Several experimental studies described a pressure-related reduction in hepatic blood flow, whereas other investigators reported an increase as long as the intraabdominal pressure (IAP) remained less than 16 mm Hg. Our goal in the present study was to investigate the effects of insufflated CO(2) on hepatic blood flow during laparoscopic surgery in healthy adults. Blood flow in the right and middle hepatic veins was assessed in 24 patients undergoing laparoscopic surgery by use of transesophageal Doppler echocardiography. Hepatic venous blood flow was recorded before and after 5, 10, 20, 30, and 40 min of pneumoperitoneum, as well as 1 and 5 min after deflation. Twelve patients undergoing conventional hernia repair served as the control group. The induction of pneumoperitoneum produced a significant increase in blood flow of the right and middle hepatic veins. Five minutes after insufflation of CO(2) the median right hepatic blood flow index increased from 196 mL/min/m(2) (95% confidence interval (CI), 140-261 mL/min/m(2)) to 392 mL/min/m(2) (CI, 263-551 mL/min/m(2)) (P < 0.05) and persisted during maintenance of pneumoperitoneum. In the middle hepatic vein the blood flow index increased from 105 mL/min/m(2) (CI, 71-136 mL/min/m(2)) to 159 mL/min/m(2) (CI, 103-236 mL/min/m(2)) 20 min after insufflation of CO(2). After deflation blood flow returned to baseline values in both hepatic veins. Conversely, in the control group hepatic blood flow remained unchanged over the entire study period. We conclude that induction of CO(2) pneumoperitoneum with an IAP of 12 mm Hg is associated with an increase in hepatic perfusion in healthy adults.

Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients

“…Laparoscopic cholecystectomy using low-pressure pneumoperitoneum (7 mmHg) also has been shown to minimize adverse hemodynamic effects on hepatic portal blood flow and hepatic function [25]. Meierhenrich et al [13] reported well-preserved, even increased, hepatic blood flow during laparoscopic cholecystectomy (LCC) measured with advanced transesophageal echocardiography [13]. In our study, we observed no adverse effects on hepatic function, as measured by laboratory parameters, or on liver perfusion, as measured with indocyanin clearance, when IAP was kept between 8 and 12 mmHg.…”

Influence of Hemodynamic Variations on the Pharmacokinetics of Landiolol in Patients Undergoing Cardiovascular Surgery

“…15,16) Hypotension due to decreased systemic vascular resistance may reduce hepatic blood flow, because a nearly linear correlation between systemic arterial blood pressure and hepatic arterial blood flow has been found. 17,18) In previous studies, hepatic blood flow has been measured using intraoperative transesophageal echocardiography to investigate the effect of laparoscopic cholecystectomy, 19) intraabdominally insufflated carbon dioxide, 20) and thoracic epidural anesthesia. 21) In these studies, hepatic blood flow was reported to be decreased by laparoscopy and thoracic epidural anesthesia, and increased by insufflated carbon dioxide.…”

“…19,20,[24][25][26] To visualize the hepatic veins, the tip of the probe was advanced into the antrum of the stomach and flexed anteriorly. The Doppler sonography curve was attained by pulsed wave Doppler technique (PWmode).…”

“…The correction factor k is derived from an experimental study in pigs and takes into account that the blood flow is not flat but has a parabolic velocity profile. 20,26) Blood flow indexes of the right and middle hepatic vein were calculated by dividing the hepatic blood flow by the body surface area.…”

“…38,39) Recently, TEE has been reported to be effective for evaluating hepatic blood flow during the intraoperative period. [16][17][18][19][20][21] However, 3 to 27% of patients receiving TEE evaluation of hepatic blood flow are reported to present poor quality sonographic images. 20,21,25) In this study, decreased HVBFI was observed after administration of heparin with one excluded patient (5%, 1/19).…”